The state of Ohio’s efforts to address prescription painkiller abuse have met with success according to new data released by the Ohio Department of Health (ODH). The number of deaths from unintended overdoses of prescription opiates declined in 2012, the first such decline in over a decade. However, the same data indicated a rise in the number of deaths from overdoses of illegal opiates, such as heroin, reinforcing the growing problem of the illegal drug in the state.

Prescription drug decline. The ODH reported that there were 697 deaths in 2012 from unintended overdoses of prescription opiates, down from 789 in 2011, a decline of nearly 12 percent. This is the first decline since 2003 when there were 221 deaths. Until 2012 there had been a steady increase in drug overdose deaths, with deaths rising 366 percent between 2000 and 2012. Prescription drugs were the largest part of that increase. Recent efforts to combat opioid abuse in Ohio include the launch of the “Start Talking!” program, establishment of a six-county drug court pilot for treatment of opiate abuse and the funding of a pilot to improve health outcomes and reduce costs associated with Neonatal Abstinence Syndrome (NAS).

Part of the observed decrease in unintended overdoses may be attributable to fewer patients prescribed the painkillers. In 2013, more than 200,000 fewer patients were prescribed high levels of painkillers compared with 2010. In a report from the Ohio Board of pharmacy, via the Ohio Automated Rx Reporting System show that last year, 326,111 Ohioans were red-flagged for being prescribed high levels of narcotic painkillers. The numbers represent a nearly 41 percent drop from the 549,519 patients who received high doses in 2010. Previously, the Ohio Department of Alcohol and Drug Addiction Services had reported at one point that opiates as the drug of choice had risen from 7 percent of all clients in 2001 to 18 percent in 2009.

Heroin deaths rise, rural counties hit twice as hard. As noted, although, the 2012 data reveals the significant downward shift in prescription opioid-related overdose deaths, the decline is contrasted by an increase in heroin-related deaths. Overall, unintentional drug overdoses caused 1,914 deaths. Moreover, residents of rural counties were more than twice as lilely to overdose on prescription drugs and heroin than residents of cities. In Preble County, with around 42,000 residents, the heroin and prescription drug death rate from overdoses was at 23 for every 100,000 state residents. The state of Ohio in comparison has an overdose death rate of 15 per 100,000 residents. Although state opioid treatment programs serve 30,000 individuals a year, this number is only a tenth of what the Department of Mental Health and Addiction Services believes could be served. With costs of heroin as little as $10 for a tenth of a gram, while prescription opioids have a street value of $30 or $40, the most likely users of heroin are young people with limited incomes.

Efforts to combat problem. The expansion of Medicaid in Ohio under the Patient Protection and Affordable Care Act (P.L. 111-148) has expanded coverage of substance abuse treatment, but timely access to care seems to remain elusive for those who may need it most. The ODH noted that Ohio had undertaken a number of initiatives in 2014 alone to combat opiate addiction, including passage of HB 170 into law, which expanded the use of naloxone so that first responders can administer the drug; allowing family and friends to get prescriptions for loved ones at risk of overdosing on opioids; and grants immunity to prescribers and for those trying to save a life by administering the overdose-reversal drug.